Database: Ovid MEDLINE(R) <1996 to March Week 3 2010>
Search Strategy:
-------------------------------------------------------------------------------1 *abortion, induced/ (3791)
2 South Africa/ (12265)
3 1 and 2 (36)
4 limit 3 to english language (36)
5 from 4 keep 1-36 (36)
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<1>
Unique Identifier
19689791
Status
MEDLINE
Authors
Harries J. Stinson K. Orner P.
Authors Full Name
Harries, Jane. Stinson, Kathryn. Orner, Phyllis.
Institution
Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of
Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, South
Africa. Jane.Harries@uct.ac.za
Title
Health care providers' attitudes towards termination of pregnancy: a qualitative study in South
Africa.
Source
BMC Public Health. 9:296, 2009.
Other ID
Source: NLM. PMC2734857
Abstract
BACKGROUND: Despite changes to the abortion legislation in South Africa in 1996, barriers
to women accessing abortion services still exist including provider opposition to abortions and a
shortage of trained and willing abortion care providers. The dearth of abortion providers
undermines the availability of safe, legal abortion, and has serious implications for women's
access to abortion services and health service planning.In South Africa, little is known about the
personal and professional attitudes of individuals who are currently working in abortion service
provision. Exploring the factors which determine health care providers' involvement or
disengagement in abortion services may facilitate improvement in the planning and provision of
future services. METHODS: Qualitative research methods were used to collect data. Thirty four
in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with
health care providers who were involved in a range of abortion provision in the Western Cape
Province, South Africa. Data were analysed using a thematic analysis approach. RESULTS:
Complex patterns of service delivery were prevalent throughout many of the health care
facilities, and fragmented levels of service provision operated in order to accommodate health
care providers' willingness to be involved in different aspects of abortion provision. Related to
this was the need expressed by many providers for dedicated, stand-alone abortion clinics
thereby creating a more supportive environment for both clients and providers. Almost all
providers were concerned about the numerous difficulties women faced in seeking an abortion
and their general quality of care. An overriding concern was poor pre and post abortion
counselling including contraceptive counselling and provision. CONCLUSION: This is the first
known qualitative study undertaken in South Africa exploring providers' attitudes towards
abortion and adds to the body of information addressing the barriers to safe abortion services. In
order to sustain a pool of abortion providers, programmes which both attract prospective
abortion providers, and retain existing providers, needs to be developed and financial
compensation for abortion care providers needs to be considered.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<2>
Unique Identifier
19418325
Status
MEDLINE
Authors
Patel CJ. Kooverjee T.
Authors Full Name
Patel, Cynthia J. Kooverjee, Trisha.
Institution
School of Psychology, University of KwaZulu-Natal, Durban, South Africa. patelc@ukzn.ac.za
Title
Abortion and contraception: attitudes of South african university students.
Source
Health Care for Women International. 30(6):550-68, 2009 Jun.
Abstract
Despite the availability of contraception, the rates of abortion among young women in South
Africa continue to increase. We designed a study to examine young people's attitudes about
abortion and contraception. One hundred and eighty-eight South African university students (97
females and 91 males) completed the survey. While we found moral objections to abortion for the
sample as a whole, females showed stronger support for availability of abortion and women's
autonomy compared with males. The respondents acknowledged the importance of contraception
at a personal and general level, but more than 40% of them believed that women who use
contraception are promiscuous. Females expressed difficulty with usage more frequently than
males and indicated that they would not consider sexual intercourse if contraception were not
available. For health care workers involved in counseling young people about their sexual and
reproductive choices, the challenge lies in promoting a culture of equal rights and respect for
women's reproductive freedom.
Publication Type
Journal Article.
<3>
Unique Identifier
18772094
Status
MEDLINE
Authors
Hyman AG. Baird TL. Basnett I.
Authors Full Name
Hyman, Alyson G. Baird, Traci L. Basnett, Indira.
Institution
Ipas, Chapel Hill, NC, USA. hymana@ipas.org
Title
Establishing second trimester abortion services: experiences in Nepal, Viet Nam and South
Africa.
Source
Reproductive Health Matters. 16(31 Suppl):135-44, 2008 May.
Abstract
This paper describes experiences and lessons learned about how to establish safe second
trimester abortion services in low-resource settings in the public health sector in three countries:
Nepal, Viet Nam and South Africa. The key steps involved include securing the necessary
approvals, selecting abortion methods, organising facilities, obtaining necessary equipment and
supplies, training staff, setting up and managing services, and ensuring quality. It may take a
number of months to gain the necessary approvals to introduce or expand second trimester
services. Advocacy efforts are often required to raise awareness among key governmental and
health system stakeholders. Providers and their teams require thorough training, including
values clarification; monitoring and support following training prevents burn-out and ensures
quality of care. This paper shows that good quality second trimester abortion services are
achievable in even the most low-resource settings. Ultimately, improvements in second trimester
abortion services will help to reduce abortion-related morbidity and mortality.
Publication Type
Journal Article.
<4>
Unique Identifier
18772091
Status
MEDLINE
Authors
Turner KL. Hyman AG. Gabriel MC.
Authors Full Name
Turner, Katherine L. Hyman, Alyson G. Gabriel, Mosotho C.
Institution
Ipas, Chapel Hill, NC, USA. turnerk@ipas.org
Title
Clarifying values and transforming attitudes to improve access to second trimester abortion.
Source
Reproductive Health Matters. 16(31 Suppl):108-16, 2008 May.
Abstract
Access to safe second trimester abortion services is poor in many countries, sometimes despite
liberal laws and policies. Addressing the myriad factors hindering access to safe abortion care
requires a multi-pronged strategy. Workshops aimed at clarifying values are useful for
addressing barriers to access stemming from misinformation, stigmatization of women and
providers, and negative attitudes and obstructionist behaviours. They engage health care
providers and administrators, policymakers, community members and others in a process of selfexamination with the goal of transforming abortion-related attitudes and behaviours in a
direction supportive of women seeking abortion. This is especially important for women seeking
second trimester abortion, which tends to be even more stigmatized than first trimester abortion.
This paper reports on some promising experiences and results from workshops in Viet Nam,
Nepal and South Africa. Some recommendations that emerge are that values clarification should
be included in abortion training, service delivery and advocacy programmes. Evaluations of such
interventions are also needed.
Publication Type
Journal Article.
<5>
Unique Identifier
18772086
Status
MEDLINE
Authors
Alblas M.
Authors Full Name
Alblas, Marijke.
Institution
Medical Consultant, Cape Town, South Africa. malblas@iafrica.com
Title
A week in the life of an abortion doctor, Western Cape Province, South Africa.
Source
Reproductive Health Matters. 16(31 Suppl):69-73, 2008 May.
Abstract
South Africa legalized abortion in 1996. I am originally from the Netherlands and came to
South Africa in 2000, to assist in the Termination of Pregnancy programme. In March 2007, at
an international conference on second trimester abortion, I described my life as an abortion
doctor living in Cape Town, South Africa. I was urged to write down what my working life in the
Western Cape is like, and this paper is the result. It is a diary of a typical work week, recorded in
early 2008.
Publication Type
Journal Article.
<6>
Unique Identifier
17888919
Status
MEDLINE
Authors
van Bogaert LJ.
Authors Full Name
van Bogaert, L J.
Institution
Department of Obstetrics and Gynecology, Saint Rita's Hospital, Limpopo, South Africa.
ljfvanbo@lantic.net
Title
Termination of pregnancy with misoprostol in the scarred uterus.
Source
International Journal of Gynaecology & Obstetrics. 100(1):80-1, 2008 Jan.
Publication Type
Journal Article.
<7>
Unique Identifier
18264602
Status
MEDLINE
Authors
Bateman C.
Authors Full Name
Bateman, Chris.
Title
Maternal mortalities 90% down as legal TOPs more than triple. [Review] [0 refs]
Source
South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 97(12):1238-42,
2007 Dec.
Publication Type
Journal Article. Review.
<8>
Unique Identifier
17701803
Status
MEDLINE
Authors
van Bogaert LJ. Sedibe TM.
Authors Full Name
van Bogaert, L-J. Sedibe, T M.
Institution
Department of Obstetrics and Gynaecology, St Rita's Hospital, Glen Cowie, South Africa.
ljfvanbo@lantic.net
Title
Efficacy of a single misoprostol regimen in the first and second trimester termination of
pregnancy.
Source
Journal of Obstetrics & Gynaecology. 27(5):510-2, 2007 Jul.
Abstract
A total of 273 women underwent termination of pregnancy (TOP) with a single regimen of
misoprostol (400 microg orally and 800 microg vaginally), without mifepristone. A total of 98
(35.9%) were first trimester and 175 (64.1%) second trimester gestations. Of these women, 189
(69.2%) responded to a single administration of misoprostol and 84 (30.8%) required between
two and six administrations of misoprostol. The medical TOP was complete in 90.8% of all cases.
A surgical intervention was needed in 23 (27.4%) of those requiring repeated administrations of
misoprostol vs only two (1.1%) of those responding to a single administration. Age, parity and
gestational age did not affect the response rate to the misoprostol regimen. The need for a D&C
was related to the response to misoprostol: most D&Cs were needed in cases of repeat
administrations of misoprostol. This study shows the feasibility of medical TOP in the developing
world. It has the great advantage of significantly reducing the need for surgical termination
where the required skills are scarce.
Publication Type
Journal Article.
<9>
Unique Identifier
17439565
Status
MEDLINE
Authors
Blanchard K. Cooper D. Dickson K. Cullingworth L. Mavimbela N. von Mollendorf C. van
Bogaert LJ. Winikoff B.
Authors Full Name
Blanchard, K. Cooper, D. Dickson, K. Cullingworth, L. Mavimbela, N. von Mollendorf, C.
van Bogaert, L J. Winikoff, B.
Institution
Ibis Reproductive Health, Cambridge, MA 02138, USA.
kblanchard@ibisreproductivehealth.org
Title
A comparison of women's, providers' and ultrasound assessments of pregnancy duration among
termination of pregnancy clients in South Africa.
Source
BJOG: An International Journal of Obstetrics & Gynaecology. 114(5):569-75, 2007 May.
Abstract
OBJECTIVE: To compare providers' and women's estimates of duration of pregnancy with
ultrasound estimates for determining medical abortion eligibility. DESIGN: Cross-sectional
study. SETTING: Public termination of pregnancy (TOP) services in three provinces. SAMPLE:
A total of 673 women attending the above services for TOP. METHODS: Women participating in
a medical abortion feasibility study in South Africa provided estimates of pregnancy duration
and date of last menstrual period (LMP). Each woman also had clinical and ultrasound exams.
We compared estimates using the four methods, calculating the proportion of women in the
'caution zone' (< or = 8 weeks gestation by woman or provider estimate and > 8 weeks by
ultrasound). MAIN OUTCOME MEASURES: Mean gestational age by each method; difference
between provider and LMP estimates and ultrasound estimates; and percentage of women in the
'caution zone'. RESULTS: Women's estimates of pregnancy duration were 19 days fewer than
ultrasound estimates (95% CI = -27 to 63). Mean provider- and LMP-based estimates were two
(95% CI = -30 to 35) and less than one day(s) (95% CI = -46 to 51) fewer than ultrasound
estimates. Comparing provider and ultrasound estimates, 15% of women were in the 'caution
zone'; this fell to 12% if estimates of 9 weeks or fewer were considered acceptable.
CONCLUSIONS: Provider estimates of gestational age were sufficiently accurate for
determining eligibility for medical abortion. LMP-based estimates were also accurate on average,
but included more extreme differences from ultrasound estimates. Medical abortion could be
provided in TOP facilities without ultrasound or with ultrasound on referral.
Publication Type
Comparative Study. Journal Article. Multicenter Study. Research Support, Non-U.S. Gov't.
<10>
Unique Identifier
17484194
Status
MEDLINE
Authors
Blanchard K. Schaffer K. McLeod S. Winikoff B.
Authors Full Name
Blanchard, Kelly. Schaffer, Kate. McLeod, Shamiema. Winikoff, Beverly.
Institution
Ibis Reproductive Health, Cambridge, MA 02138, USA.
kblanchard@ibisreproductivehealth.org
Title
Medication abortion in the private sector in South Africa.
Source
European Journal of Contraception & Reproductive Health Care. 11(4):285-90, 2006 Dec.
Abstract
OBJECTIVES: To collect information about how private physicians in South Africa provide
medication abortion services to their patients. METHODS: In April 2003 we asked physicians in
private practice in South Africa who had purchased mifepristone (Mifegyne) from the South
African distributor about the medication abortion regimen they offered, satisfaction with the
method, and how services have been incorporated into their practices. RESULTS: Forty-four
providers participated in the survey. They report using a range of doses and regimens. Most
respondents offer mifepristone-misoprostol to their patients, although a significant minority also
offer misoprostol-alone for pregnancy termination. While the majority of medication abortion
providers also offer surgical abortions, a significant number of non-surgical providers were only
offering medication abortion. CONCLUSION: South African medication abortion providers find
the method acceptable, indicate that their staff are largely supportive of offering it to their
patients, and report that clients like the method. Those surveyed believe that most of their
patients are eligible for the regimen, although uptake has been limited.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<11>
Unique Identifier
17167706
Status
MEDLINE
Authors
Pattinson RC. Snyman LC. Macdonald AP.
Authors Full Name
Pattinson, R C. Snyman, L C. Macdonald, A P.
Institution
MRC Maternal and Infant Health Care Strategies Research Unit and Department of Obstetrics
and Gynaecology, University of Pretoria, South Africa.
Title
Evaluation of a strict protocol approach in managing women with severe disease due to
abortion.
Source
South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 96(11):1191-4,
2006 Nov.
Abstract
AIM: To evaluate whether the introduction of a strict protocol approach based on the systemic
evaluation of critically ill pregnant women with complications of abortion affected outcome.
SETTING: Indigent South Africans managed in the regional and tertiary hospitals of the
Pretoria Academic Complex. METHOD: Since 1997 a standard definition of severe acute
maternal morbidity (SAMM) has been used in the Pretoria Academic Complex. All cases of
SAMM and maternal deaths were entered on the Maternal Morbidity and Mortality Audit
System programme. A comparison of outcome of severely ill women who had complications of
abortion was made between 1997-1998 (original protocol) and 2002-2004 (strict protocol).
OUTCOME MEASURES: The mortality index and prevalence of organ system failure or
dysfunction. RESULTS: In 1997-1998 there were 43 women with SAMM who survived and a
further 10 maternal deaths due to complications of abortion, compared with 107 women with
SAMM and 7 maternal deaths during 2002-2004. The mortality index declined from 18.9% in
1997-1998 to 6.1% in 2002-2004 (p = 0.02, odds ratio 0.28, 95% confidence limits 0.10 - 0.79).
Significantly more women had hypovolaemic shock in 2002-2004 compared with 1997-1998
(54.4% v. 35.8%, p = 0.04), but fewer women had immune system failure including septic shock
(18.4% v. 47.2%, p = 0.0002) and metabolic dysfunction (0 v. 5.7%, p = 0.03) and there was a
trend to less renal failure (10.5% v. 22.6%, p = 0.06) and cardiac failure (4.4% v. 13.2%, p =
0.08). CONCLUSION: The strict protocol approach based on systemic evaluation in managing
critically ill pregnant women with complications of abortion, coupled with an intensive, regular
feedback mechanism, has been associated with a reduction in the mortality index.
Publication Type
Evaluation Studies. Journal Article. Multicenter Study.
<12>
Unique Identifier
17141703
Status
MEDLINE
Authors
Warriner IK. Meirik O. Hoffman M. Morroni C. Harries J. My Huong NT. Vy ND. Seuc
AH.
Authors Full Name
Warriner, I K. Meirik, O. Hoffman, M. Morroni, C. Harries, J. My Huong, N T. Vy, N D.
Seuc, A H.
Institution
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research
Training in Human Reproduction, Department of Reproductive Health and Research, WHO,
Geneva 1211, Switzerland. warrineri@who.int
Title
Rates of complication in first-trimester manual vacuum aspiration abortion done by doctors
and mid-level providers in South Africa and Vietnam: a randomised controlled equivalence trial.
Comments
Comment in: Lancet. 2006 Dec 2;368(9551):1939-40; PMID: 17141683]
Source
Lancet. 368(9551):1965-72, 2006 Dec 2.
Abstract
BACKGROUND: We assessed whether the safety of first-trimester manual vacuum aspiration
abortion done by health-care providers who are not doctors (mid-level providers) is equivalent to
that of procedures done by doctors in South Africa and Vietnam, where mid-level providers are
government trained and accredited to do first-trimester abortions. METHODS: We did a
randomised, two-sided controlled equivalence trial to compare rates of complication in abortions
done by the two groups of providers. An a-priori margin of equivalence of 4.5% with 80% power
and 95% CI (alpha=0.05) was used. 1160 women participated in South Africa and 1734 in
Vietnam. Women presenting for an induced abortion at up to 12 weeks' gestation were randomly
assigned to a doctor or a mid-level provider for manual vacuum aspiration and followed-up 1014 days later. The primary outcome was complication of abortion. Complications were recorded
during the abortion procedure, before discharge from the clinic, and at follow-up. Per-protocol
and intention-to-treat analyses were done. This trial is registered at with the identifier .
FINDINGS: In both countries, rates of complication satisfied the predetermined statistical
criteria for equivalence: rates per 100 patients in South Africa were 1.4 (eight of 576) for midlevel providers and 0 for doctors (difference 1.4, 95% CI 0.4 to 2.7); in Vietnam, rates were 1.2
(ten of 824) for mid-level providers and 1.2 (ten of 812) for doctors (difference 0.0, 95% CI -1.2 to
1.1). There was one immediate complication related to analgesics. Delayed complications were
caused by retained products and infection. INTERPRETATION: With appropriate government
training, mid-level health-care providers can provide first trimester manual vacuum aspiration
abortions as safely as doctors can.
Publication Type
Journal Article. Multicenter Study. Randomized Controlled Trial. Research Support, NonU.S. Gov't.
<13>
Unique Identifier
16909172
Status
MEDLINE
Authors
Morroni C. Moodley J.
Authors Full Name
Morroni, Chelsea. Moodley, Jennifer.
Title
Characteristics of clients seeking first- and second-trimester terminations of pregnancy in
public health facilities in Cape Town.
Source
South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 96(7):574, 2006
Jul.
Publication Type
Letter.
<14>
Unique Identifier
16366017
Status
MEDLINE
Authors
International Consortium for Medical Abortion.
Authors Full Name
International Consortium for Medical Abortion.
Title
Medical abortion: expanding access to safe abortion and saving women's lives. [0 refs]
Source
Reproductive Health Matters. 13(26):11-2, 2005 Nov.
Publication Type
Consensus Development Conference. Editorial.
<15>
Unique Identifier
16291484
Status
MEDLINE
Authors
Cooper D. Dickson K. Blanchard K. Cullingworth L. Mavimbela N. von Mollendorf C. van
Bogaert L. Winikoff B.
Authors Full Name
Cooper, Diane. Dickson, Kim. Blanchard, Kelly. Cullingworth, Lee. Mavimbela, Nqobile. von
Mollendorf, Clare. van Bogaert, Louis. Winikoff, Beverly.
Institution
Women's Health Research Unit, School of Public Health and Family Medicine, University of
Cape Town, Cape Town, South Africa.
Title
Medical abortion: the possibilities for introduction in the public sector in South Africa.
Source
Reproductive Health Matters. 13(26):35-43, 2005 Nov.
Abstract
Medical abortion is safe and effective and has been approved for use in early termination of
pregnancy in South Africa since 2001. The Department of Health is currently considering its
introduction in the public health sector. The attitudes of women seeking abortion and of health
care providers towards medical abortion have not previously been described. Data were derived
from a quantitative survey of 673 women attending abortion services in the provinces of
Gauteng, Mpumalanga and the Western Cape. In-depth interviews in Soweto and Cape Town
were conducted with 20 public health doctors, nurses, a social worker and facility managers, and
in Cape Town with four provincial policymakers. Although medical abortion was not yet being
offered, 21% of women interviewed were early enough in pregnancy (eight weeks or less) to be
eligible for medical abortion. Access to health facilities, including those for abortion, was
reasonable for urban women but more limited for rural women. Rural women also incurred
greater travel costs to reach a facility. Most women thought medical abortion would be
acceptable and would have been willing to try it, had it been available. Policymakers and
providers were supportive, as they felt medical abortion could relieve the burden on current
services. How to increase access to abortion services in rural areas needs to be addressed.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<16>
Unique Identifier
16105333
Status
MEDLINE
Authors
Owolabi OT. Moodley J.
Authors Full Name
Owolabi, O T. Moodley, J.
Institution
Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, Durban,
South Africa.
Title
A randomized trial of pain relief in termination of pregnancy in South Africa.
Source
Tropical Doctor. 35(3):136-9, 2005 Jul.
Abstract
The aim of this prospective trial was to evaluate and compare paracervical block with
diclofenac for pain relief during manual vacuum aspiration (MVA) for surgical termination of
pregnancy. Participants were randomized into three groups, viz. group (i) diclofenac 75 mg
intramuscularly (i.m.) 30 min before the procedure; (ii) diclofenac 75 mg i.m. 30 min before the
procedure, together with local infiltration of the cervix with lignocaine 1% (10 mL); (iii)
diclofenac 75 mg i.m. 30 min before the procedure together with local infiltration of the cervix
with lignocaine 1% (10 mL) and paracervical block with lignocaine 1% (5 mL). There was a
significant difference in pain scores during the procedure between groups (i) and (ii) (P < 0.001),
and between groups (i) and (iii) (P < 0.001) in pain scores during the procedure. There was no
difference in pain score between groups (ii) and (iii) (P = 0.144). Post procedure analysis of pain
score also showed significant difference between group (i) on one hand, and groups (ii) and (iii)
(P < 0.001), but no significant difference between groups (ii) and (iii)(P = 0.029). The local
anaesthetic infiltration of the cervix in combination with diclofenac or together with diclofenac
and paracervical block provides better pain relief during and after the MVA.
Publication Type
Clinical Trial. Journal Article. Randomized Controlled Trial.
<17>
Unique Identifier
16101602
Status
MEDLINE
Authors
Jewkes RK. Gumede T. Westaway MS. Dickson K. Brown H. Rees H.
Authors Full Name
Jewkes, Rachel K. Gumede, Tebogo. Westaway, Margaret S. Dickson, Kim. Brown, Heather.
Rees, Helen.
Institution
Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa.
Title
Why are women still aborting outside designated facilities in metropolitan South Africa?.
Source
BJOG: An International Journal of Obstetrics & Gynaecology. 112(9):1236-42, 2005 Sep.
Abstract
OBJECTIVE: To explore why South African women still abort outside designated services
where there is substantial legal service provision. DESIGN: Descriptive study. SETTING: Three
hospitals in Gauteng Province in South Africa. Sample Forty-six women attending hospital with
incomplete abortion who had abortions induced outside of designated facilities. METHODS: An
interviewer-administered questionnaire with open and closed questions was completed. Induction
status was determined from answers to a set of closed questions. Open-ended questions explored
the circumstances of induction. Main focus of interviews Methods of induction used, barriers to
legal service use. RESULTS: Nearly two-thirds of women (n= 38) had self-induced or had
consulted a traditional healer. A minority of these women (n= 11) indicated that they did this
because they experienced barriers to legal service use. For others it was presented as a 'natural'
response to a health problem (unwanted pregnancy). Several women (n= 10) were given
misoprostol by a doctor, nurse, or pharmacist. Fifty-four percent of the women had not used
legal services because they did not know about the law, while 15% knew of their legal rights, but
did not know of a legal facility. Others did know where to access legal services but feared rude
staff (17%) or breaches of confidentiality (6.5%). Others (6.5%) had been unable to get a legal
abortion early enough in pregnancy to comply with the law. CONCLUSIONS: Lack of
information on abortion rights under the Act and perceived poor quality of designated facilities
were the most important barriers to access and should be addressed by policymakers and health
service management. The willingness of women to self-medicate and visit traditional healers in
these circumstances may influence the overall ability of the new legislation to reduce abortion
morbidity.
Publication Type
Journal Article. Multicenter Study.
<18>
Unique Identifier
15889846
Status
MEDLINE
Authors
Jewkes R. Rees H.
Authors Full Name
Jewkes, Rachel. Rees, Helen.
Title
Dramatic decline in abortion mortality due to the Choice on Termination of Pregnancy Act.
Source
South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 95(4):250, 2005
Apr.
Publication Type
Letter.
<19>
Unique Identifier
15854634
Status
MEDLINE
Authors
le Roux PA. van der Spuy ZM.
Authors Full Name
le Roux, Paul A. van der Spuy, Zephne M.
Institution
Reproductive Medicine Unit, Department of Obstetrics and Gynaecology, Faculty of Health
Sciences, University of Cape Town/Groote Schuur Hospital, P.O. Box 34584, Groote Schuur,
7937, Cape Town, South Africa. pleroux@absamail.co.za
Title
Labor induction abortion utilizing trilostane, a 3beta-hydroxysteroid dehydrogenase inhibitor.
Source
Contraception. 71(5):343-7, 2005 May.
Abstract
Labor induction abortion in the second trimester is a difficult problem in developing countries
because antiprogestins are either not available or unaffordable. When prostaglandins are used
alone for labor induction abortion without antiprogestin pretreatment, the induction to delivery
interval and the treatment failure rate increase. Trilostane, an inhibitor of 3beta-hydroxysteroid
dehydrogenase enzyme system, was given to 93 women between 13 and 19 weeks gestation. The
trilostane dosage used was 120 mg twice daily for the first 24 h, and then 240 mg twice daily for
the next 24 h. The women returned after 48 h for hospital admission. The women were
randomized to three different misoprostol regimens: low-dose vaginal group (200 microg every 4
h), high-dose vaginal group (initial dose of 400 microg followed by 200 microg every 4 h) and
vaginal-oral group (400 microg vaginally followed by 200 microg orally every 4 h). The median
induction to abortion times were 17, 8.3 and 9.4 h, respectively. The latter two groups had
significantly shorter induction to delivery times (p<.05). The most common side effects were a
burning feeling in the face (47.7%) and nausea (13.3%). Overall, trilostane side effects were mild
and self-limiting and did not interfere with therapy. In conclusion, trilostane can be given as outpatient therapy prior to admission for prostaglandin administration in labor induction abortion.
Publication Type
Clinical Trial. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S.
Gov't.
<20>
Unique Identifier
15532749
Status
MEDLINE
Authors
Bateman C.
Authors Full Name
Bateman, Chris.
Title
Kopanong in a spin over TOP.
Source
South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 94(10):808-9, 2004
Oct.
Publication Type
News.
<21>
Unique Identifier
12638811
Status
MEDLINE
Authors
Buga GA.
Authors Full Name
Buga, G A B.
Institution
University of Transkei, Private Bag X01, Unitra, Umtata, South Africa.
Title
Attitudes of medical students to induced abortion.
Source
East African Medical Journal. 79(5):259-62, 2002 May.
Abstract
BACKGROUND: Unsafe abortion causes 13% of maternal deaths worldwide. Safe abortion can
only be offered under conditions where legislation has been passed for legal termination of
unwanted pregnancy. Where such legislation exists, accessibility of safe abortion depends on the
attitudes of doctors and other healthcare workers to induced abortion. Medical students as
future doctors may have attitudes to abortion that will affect the provision of safe abortion. Little
is known about the attitudes of South African medical students to abortion. OBJECTIVES: To
assess sexual practices and attitudes of medical students to induced abortion and to determine
some of the factors that may influence these attitudes. DESIGN: A cross-sectional analytic study
involving the self-administration of an anonymous questionnaire. SETTING: The questionnaire
was administered to medical students at a small, but growing, medical school situated in rural
South Africa. MAIN OUTCOME MEASURES: Demographic data, sexual practices and
attitudes to induced abortion. RESULTS: Two hundred and forty seven out of 300 (82.3%)
medical students responded. Their mean age was 21.81 +/- 3.36 (SD) years, and 78.8% were
Christians, 17.1% Hindus and 2.6% Muslims. Although 95% of the respondents were single,
68.6% were already sexually experienced, and their mean age at coitarche was 17.24+/-3.14 (SD)
years. Although overall 61.2% of the respondents felt abortion is murder either at conception or
later, the majority (87.2%) would perform or refer a woman for abortion under certain
circumstances. These circumstances, in descending order of frequency, include: threat to
mother's life (74.1%), in case of rape (62.3%), the baby is severely malformed (59.5%), threat to
mother's mental health (53.8%) and parental incompetence (21.0%). Only 12.5% of respondents
would perform or refer for abortion on demand, 12.8% would neither perform nor refer for
abortion under any circumstances. Religious affiliation and service attendance significantly
influenced some of these attitudes and beliefs. CONCLUSION: Although many of the medical
students personally felt abortion is murder, the majority are likely to perform or refer patients
for abortion under certain circumstances; only about a tenth are likely to perform or refer
patients for abortion on demand.
Publication Type
Journal Article.
<22>
Unique Identifier
12553186
Status
MEDLINE
Authors
Varga CA.
Authors Full Name
Varga, Christine A.
Institution
Child, Youth, and Family Development, Human Sciences Research Council, Durban, South
Africa. cvarga@hsrc.ac.za
Title
Pregnancy termination among South African adolescents.
Source
Studies in Family Planning. 33(4):283-98, 2002 Dec.
Abstract
Although African adolescents' risk of undergoing abortion and of related health complications
is well-documented, little is known about the procedure's prominence in their lives and the
pathways that lead to their reliance upon it. This study investigates abortion dynamics among
male and female Zulu adolescents in KwaZulu/Natal, South Africa. It explores the role of
abortion in young people's sexual and reproductive experience, its acceptability, the reasons and
likelihood of young people's choosing abortion, and the commonly used methods of pregnancy
termination. The study, a rural-urban comparison using focus-group discussions, narrative
workshops, and role playing, involved surveys and in-depth interviews. Factors contributing to
the commonplace nature of backstreet procedures among adolescents include: social stigma,
inadequate knowledge of the legal status of abortion, and a complex group decisionmaking
process. Young people invoke "relative moralities" concerning adolescent abortion, recognizing
and condoning it on a context-specific basis. Age, gender, and geographic differences are
examined. The methodological triangulation used offers the opportunity for alternative
theoretical and methodological approaches to research on abortion-related issues.
Publication Type
Comparative Study. Journal Article.
<23>
Unique Identifier
12146118
Status
MEDLINE
Authors
Bateman C.
Authors Full Name
Bateman, Chris.
Title
Department to take up GP abortion offer.
Source
South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 92(6):406-7, 2002
Jun.
Publication Type
News.
<24>
Unique Identifier
11993259
Status
MEDLINE
Authors
Jali MN.
Authors Full Name
Jali, M N.
Institution
Department of Nursing Science, University of the North.
Title
Abortion--a philosophical perspective. [Review] [8 refs]
Source
Curationis. 24(4):25-31, 2001 Nov.
Abstract
The central issue in the abortion debate is the moral status of the conceptus. There are two
positions that argue this issue. At one extreme are the views of the pro-life group which argues
that human life begins at the moment of conception whilst at the other are views of the pro-choice
group that argues in favour of a woman's right to self-determination. Two basic principles come
into conflict in this debate, namely the Value of Life and that of Self-determination. In this paper
the arguments forwarded by each group in justification of its position are presented. Also
discussed is the moderate developmental viewpoint which accepts that the genetic basis of an
individual is established at conception. Some development, however, has to occur before the
conceptus can be called a person. The fact that an entity is a potential person is a prima facie
reason for not destroying it. On the other hand, we need not conclude that a person has a right to
life by virtue of that potentiality. Simultaneously we should recognise that the right a potential
entity has, may be nullified by the woman's right to self-determination. [References: 8]
Publication Type
Journal Article. Review.
<25>
Unique Identifier
11140033
Status
MEDLINE
Authors
Gmeiner AC. Van Wyk S. Poggenpoel M. Myburgh CP.
Authors Full Name
Gmeiner, A C. Van Wyk, S. Poggenpoel, M. Myburgh, C P.
Title
Support for nurses directly involved with women who chose to terminate a pregnancy.
Source
Curationis. 23(1):70-8, 2000 Mar.
Abstract
Research conducted by Poggenpoel, Myburgh and Gmeiner (1998:2-8) on "One voice regarding
the legalization of abortion: Nurses who experience discomfort" indicated that the nurses were in
favour of the fact that nurses should volunteer to participate in terminating a pregnancy of a
woman. From our observations in clinics where nurses voluntarily participate in providing
reproductive health services, including termination of pregnancy, it became clear that supporting
these nurses may be essential. To be able to provide support, it is necessary to identify, explore
and describe nurses' experience of being directly involved with women who terminate their
pregnancy. To enable us to address the identified problems, a qualitative research strategy was
implemented in which respondents were included in the sample through purposive sampling.
Phenomenological interviews were conducted individually. Data was analyzed by means of
Tesch's descriptive approach. Thereafter, guidelines for operationalization were inferred from
the results and a literature control completed to verify and enrich guidelines. Measures to ensure
trustworthiness have been applied in the research and ethical measures have been strictly
adhered to regarding this sensitive issue.
Publication Type
Journal Article.
<26>
Unique Identifier
12425313
Status
MEDLINE
Authors
Slabbert MN.
Authors Full Name
Slabbert, M N.
Institution
Department of Jurisprudence, University of South Africa.
Title
The position of the human embryo and foetus in international law and its relevance for the
South African context.
Source
Comparative & International Law Journal of Southern Africa. 32(3):336-53, 1999 Nov.
Other ID
Source: KIE. 105234
Source: NRCBL. VF 9.5.8
Publication Type
Journal Article.
<27>
Unique Identifier
12294838
Status
MEDLINE
Authors
Becker B.
Authors Full Name
Becker, B.
Title
78,000 women die each year from unsafe abortions worldwide. It is estimated that there are 20
million unsafe abortions per year on a global basis.
Source
Reproductive Freedom News. 8(3):1, 5, 1999 Mar.
Other ID
Source: PIP. 140297
Source: POP. 00283822
Other Abstract
At February's Cairo+5 proceedings at the Hague, the Center for Reproductive Law and Policy
(CRLP) called a press conference to discuss changes in abortion laws around the world since the
International Conference on Population and Development in Cairo in 1994. According to the
director of CRLP's International Program, 9 countries have modified their abortion laws since
Cairo. Of those, 7 liberalized their laws, while Poland and El Salvador further restricted
legislation. The CRLP supports the liberalization of abortion laws for all women in all countries.
Abortion law has been liberalized in South Africa since Cairo, with the enactment in 1997 of the
Termination of Pregnancy Act. In contrast, however, anti-choice groups in Poland successfully
challenged the legality of abortion in 1996 by declaring it against the Polish Constitution.
Abortion is prohibited in Chile in all circumstances, even to save the life of the woman. However,
despite the illegality of abortion in that country, half of all pregnancies in Chile end in abortion.
Unsafe abortion contributes to the 50% maternal mortality rate in Nepal. Abortion in the
country is punishable by a 20-year prison sentence, regardless of the age of the woman.
Publication Type
Journal Article.
<28>
Unique Identifier
10734504
Status
MEDLINE
Authors
Okanlomo KA. Ngotho D. Moodley J.
Authors Full Name
Okanlomo, K A. Ngotho, D. Moodley, J.
Institution
Department of Obstetrics and Gynaecology, University of Natal Medical School, Durban, South
Africa.
Title
Effect of misoprostol for cervical ripening prior to pregnancy interruption before twelve weeks
of gestation.
Source
East African Medical Journal. 76(10):552-5, 1999 Oct.
Abstract
BACKGROUND: Liberalization of the law in respect of legal abortions has led to a search for
an appropriate technique for termination of pregnancy. The technique should be cheap, easy to
perform and have minimal or no complications. AIM: To evaluate the effectiveness of
performing manual vacuum aspiration (MVA) with and without the use of misoprostol to the
procedure. DESIGN: Randomised control study. SETTING: Obstetrics and Gynaecology
Department, University of Natal Medical School, South Africa. RESULTS: One hundred and
thirty six women were recruited; 70 women were assigned to the misoprostol group. Of these, 11
(15%) did not show any change in cervical score. Their mean cervical dilatation was similar to
the control group (3.3 versus 31; p > 0.06). In the group whose gestational age was less than eight
weeks, the time taken to complete the procedure, quantity of products of conception and cervical
dilatation, were different from that of the control group, and this reached statistical significance
except quantity of products of conception in primigravidae. In pregnancies greater than eight
weeks gestation, all parameters assessed, such as cervical dilatation, quantity of products of
conception was significantly different from the control group, in both multi- and primigravidae.
Pain score was similar for all gestations. CONCLUSION: Misoprostol is of specific value during
MVA for voluntary interruption of pregnancy.
Publication Type
Clinical Trial. Journal Article. Randomized Controlled Trial.
<29>
Unique Identifier
11645069
Status
MEDLINE
Authors
Sidley P.
Authors Full Name
Sidley, Pat.
Title
South Africa's liberal abortion laws challenged.
Source
BMJ. 316(7146):1696, 1998 Jun 6.
Other ID
Source: KIE. 58244
Source: NLM. PMC1174780
Publication Type
Journal Article. News.
<30>
Unique Identifier
9418421
Status
MEDLINE
Authors
Maforah F. Wood K. Jewkes R.
Authors Full Name
Maforah, F. Wood, K. Jewkes, R.
Institution
National Urbanisation and Health Programme, Medical Research Council, Parow.
Title
Backstreet abortion: women's experiences.
Source
Curationis. 20(2):79-82, 1997 Jul.
Other ID
Source: PIP. 131497
Source: POP. 00276871
Abstract
AIM: This was a descriptive study aimed at exploring the personal experiences of women who
induce abortion and the circumstances surrounding induced abortion. METHODS: The study
was conducted in six public hospitals in four different provinces: Baragwanath (Gauteng),
Groote Schuur and Tygerberg (Western Cape), King Edward and R.K. Khan (Kwa-Zulu/Natal)
and Livingstone (Eastern Cape). In-depth interviews were conducted with 25 African, Indian and
Coloured women admitted to the hospitals following backstreet abortions. The study gave women
the opportunity to "speak for themselves" about "why" and "how" and the context in which the
unsafe induced abortions occurred. RESULTS: The findings show that a host of factors were
important in the circumstances leading to unwanted pregnancy and induced abortion: socioeconomic, cultural, psychological and societal. Disempowerment in relationships combined with
financial pressures constituted the background as to why women felt forced to terminate their
pregnancies. The perceived need for termination was found to over-ride all other considerations,
including religious ones. The ways in which women attempted to procure abortion, both through
legal and illegal routes, are presented. Wider social and legal discourses an abortion were found
to be an important factor in how women experienced their situation.
Other Abstract
In order to determine why and how women in South Africa obtain illegal abortions, a
descriptive study was conducted in six public hospitals in four provinces. Data were gathered via
semi-structured, in-depth interviews with 25 women hospitalized with complications of selfconfessed induced abortion (64% Africa, 20% Indian, and 16% Colored). 3 of the 5 married
women were separated from their husbands. Almost half of the subjects were adolescents, and
the mean age was 25 years. All of the women were aware of contraceptives but failed to use them
or used them improperly. In some cases, the male partners disapproved of contraception or
initiated intercourse in such a way that disempowered the women, making them unable to
negotiate contraceptive usage. Most of the women felt they had no choice but to seek abortion
because their sexual relationships or financial circumstances were unstable. The compulsion to
seek abortion overrode all legal and religious considerations. The women, who had to self-induce
or seek illegal abortion, felt that the current law placed a tremendous burden on them at a time
of extreme trauma. The women also complained about their treatment at the hands of the
abortionists and, later, by the hospital staff. Thus, the 1975 abortion and Sterilization Act has
failed to limit the number of abortions. The law should be amended to make abortion accessible,
safe, and less expensive to obtain. In addition, men should be targeted recipients of family
planning and contraception information.
Publication Type
Journal Article.
<31>
Unique Identifier
9322338
Status
MEDLINE
Authors
Jewkes RK. Fawcus S. Rees H. Lombard CJ. Katzenellenbogen J.
Authors Full Name
Jewkes, R K. Fawcus, S. Rees, H. Lombard, C J. Katzenellenbogen, J.
Institution
CERSA-Women's Health, Centre for Epidemiological Research in Southern Africa, Medical
Research Council, Pretoria, South Africa.
Title
Methodological issues in the South African incomplete abortion study.
Source
Studies in Family Planning. 28(3):228-34, 1997 Sep.
Other ID
Source: PIP. 127970
Source: POP. 00269148
Abstract
In 1994, a national hospital-based study was undertaken of cases of incomplete abortion
presenting to public hospitals in South Africa. Data were collected for all women admitted to a
random sample of hospitals with incomplete abortion during a two-week period. The WHO
protocol for such studies was used as a basis for developing the methods to describe the
epidemiology of incomplete abortion and hospital management of cases. Attempts were made to
estimate the proportion of cases that might have been induced. This report focuses on
methodological issues arising from the study that have implications for future research. The
findings demonstrate that only a small proportion of the women acknowledged having had an
induced abortion and that only a few of those who did showed evidence of interference with
pregnancy. Clinical opinion of sepsis and the likelihood of induction were found to be highly
unreliable. These findings considerably reduce the usefulness of the WHO-protocol method of
estimating the likely origin of incomplete abortions. Results presented in terms of three partially
overlapping descriptive categories are judged to better reflect the limitations of the data
collected.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
<32>
Unique Identifier
9254779
Status
MEDLINE
Authors
Jewkes RK. Wood K. Maforah NF.
Authors Full Name
Jewkes, R K. Wood, K. Maforah, N F.
Title
Backstreet abortion in South Africa.
Comments
Comment on: S Afr Med J. 1997 Apr;87(4):432-7; PMID: 9254785]
Source
South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 87(4):417-8, 1997
Apr.
Other ID
Source: KIE. 64771
Source: NRCBL. 12.1
Publication Type
Comment. Editorial. Historical Article.
<33>
Unique Identifier
12321538
Status
MEDLINE
Authors
Suffla S.
Authors Full Name
Suffla, S.
Title
Experiences of induced abortion among a group of South African women.
Source
South African Journal of Psychology. 27(4):214-22, 1997 Dec.
Other ID
Source: PIP. 132529
Source: POP. 00276345
Other Abstract
In-depth interviews were conducted with five single South African women 20-31 years of age of
varying socioeconomic backgrounds who underwent illegal induced abortion before
implementation in 1996 of the Choice on Termination of Pregnancy Act. The group included two
students, a clerk, a factory worker, and a social worker. Of particular interest were the social
context of the abortion decision, the abortion procedure itself, the psychological impact of the
abortion, and perceptions of coping. Overall, the interviews indicated that the abortion decision
is multidimensional and characterized by some degree of ambivalence. The decision to abort was
based on lack of readiness to be a parent, financial hardships, pressure from the father, and fear
of disapproval on the part of family members. The manner in which women responded to the
abortion was a joint function of their psychological state and the social environment in which the
procedure occurred. Although relief was the most common postabortion psychological response,
feelings of guilt, shame, and loss also were present. Postabortion adjustment was positively
influenced by the perception of support from one's partner. Further studies of this type are
urged to help South African health providers to develop a framework for abortion counseling
aimed at minimizing postabortion psychological distress.
Publication Type
Journal Article.
<34>
Unique Identifier
12292776
Status
MEDLINE
Authors
Gerhardt AJ.
Authors Full Name
Gerhardt, A J.
Title
Abortion laws into action: implementing legal reform.
Source
Initiatives in Reproductive Health Policy. 2(1):1-3, 1997 Jan.
Other ID
Source: PIP. 128242
Source: POP. 00269768
Other Abstract
The worldwide trend towards liberalizing abortion laws has resulted in reduced abortionrelated mortality in areas where legal abortion is accessible. In countries considering abortion
reform, policy-makers and health care providers have a responsibility to ensure that provisions
of any new law can be met. Preparations underway to prepare for South Africa's new abortion
law can serve as a guideline for such action. A new abortion law calls for policy changes that may
include 1) developing new standards, protocols, and guidelines for abortion care services; 2)
ensuring provision of adequate trained staff willing to provide abortions; 3) streamlining
administrative regulations to avoid delays; 4) establishing regulations and mechanisms for drug
and equipment supply and distribution; 5) restructuring the health system to accommodate
provision of abortion services; 6) allocating funds for new abortion services; and 7) reviewing
and revising security measures. In addition, health professionals will require training in abortion
provision, staff will need information updates about aspects of the legislation, and administrators
and providers in a position to impede provision of services must be made aware of the affect of
unsafe abortion on maternal health. Researchers should document the effect of the new law on
women's health, the provision of reproductive health services, and the community. IEC
(information, education, communication) activities will be required to inform the public about
the new law and services, establish sex education programs in schools and health facilities, and
mobilize family planning organizations and programs to help reduce the incidence of repeat
abortions.
Publication Type
Journal Article.
<35>
Unique Identifier
11656779
Status
MEDLINE
Authors
South Africa.
Authors Full Name
South Africa.
Title
An act (No. 92 of 1996) to determine the circumstances in which and conditions under which the
pregnancy of a woman may be terminated; and to provide for matters connected therewith. Date
of assent: 12 Nov 1996. (The Choice on Termination of Pregnancy Act, 1996). (Government
Gazette, 22 Nov 1996, Vol 377, No. 17602, pp. 1-10).
Source
International Digest of Health Legislation. 48(2):178-81, 1997.
Other ID
Source: KIE. 59593
Publication Type
Legislation.
<36>
Unique Identifier
11654533
Status
MEDLINE
Authors
Lee NC.
Authors Full Name
Lee, N C.
Title
Sweeping changes made to South Africa's abortion law.
Source
Lancet. 348(9037):1304, 1996 Nov 9.
Other ID
Source: KIE. 52993
Publication Type
Journal Article. News.